Patterns of clinical joint inflammation in juvenile idiopathic arthritis

Abstract

ObjectivesWe studied patterns of joint inflammation in juvenile idiopathic arthritis (JIA) to assess whether joint activity recurs locally in the same joints.MethodsJoints of 91 patients of the BeSt for Kids study, a treat-to-target trial for children with recent-onset oligoarticular, rheumatoid factor-negative polyarticular and psoriatic JIA, were clinically assessed during 2 years (10 study visits). The association between joint inflammation at baseline and later inflammation in the same joint was assessed using a multilevel mixed-effects logistic regression model at joint level. With a Poisson model, the association between baseline joint inflammation and the number of study visits at which the same joint was recurrently inflamed was tested.ResultsOf the 6097 joints studied, 15% (897) was clinically inflamed at baseline. In 42% (377/897) of those joints, inflammation recurred during follow-up. Joint inflammation at baseline was statistically significantly associated with joint inflammation during follow-up in the same joint (OR 3.9, 95% CI 3.5 to 4.4) and specifically with the number of episodes of recurrent joint inflammation (IRR 1.6, 95% CI 1.2 to 2.1).ConclusionIn JIA, joint inflammation has the tendency to recur multiple times in joints that are clinically inflamed at disease onset. This indicates that local factors might play a role in the processes contributing to the occurrence of JIA flares.

Evaluating the Diagnostic Performance of Systemic Immune-Inflammation Index in Childhood Inflammatory Arthritis: A Focus on Differentiating Juvenile Idiopathic Arthritis from Reactive Arthritis

“…Juvenile Idiopathic Arthritis is an immune-mediated inflammatory disease [40]. In addition to local joint inflammation [41], the ongoing inflammatory activity can alter the shape, size, and number of various cellular lineages within the hematopoietic system [42,43]. In their study, Parackova et al described the proinflammatory function of peripheral neutrophils and their interplay with platelets in developing JIA [44].…”

Inflammatory tissue priming: novel insights and therapeutic opportunities for inflammatory rheumatic diseases

“…Another related facet is that joints that were previously affected by arthritis are also significantly more likely to be afflicted during subsequent episodes,2 3 suggesting an inflammatory sensitisation of the tissue. Hyperactivated local tissue as well as the preferential recurrence of inflammatory bouts at previously affected and predilection sites are also cardinal features of CIDs of organs other than the joints, for instance, the skin, the lungs or the gut.…”

“…Individuals with inflammatory joint conditions encounter intermittent episodes of resurgent disease activity, referred to as ‘flares’ and marked by joint pain, swelling and accompanying symptoms such as fatigue 60. Previously inflamed joints are more susceptible to experiencing renewed inflammatory episodes, contributing to a worsening course of relapsing arthritis 2 3 31. Despite acute inflammation being primarily driven by infiltrating myeloid cells, this ongoing deterioration observed in relapsing arthritis is attributed to the metabolic and epigenetic priming of SFs31 59 61 (figure 2).…”